Who said you can’t go home again? HKS, Inc., designed the original Albert B. and Margaret M. Alkek Hospital at The University of Texas MD Anderson Cancer Center in Houston in the mid-1990s, working with Walter P Moore (as well as associate architects Lockwood Andrews and Newnam).

Seventeen years later, HKS returned—with Walter P Moore as well as McCarthy Building Companies, Inc.—to design and build a 500,000-square-foot addition of 12 floors atop an existing hospital. Multiple design, construction, and engineering challenges awaited the team—everything from updates in medical delivery to matching the exterior façade to construction noise and vibration.


Operational integration

In the almost 20-year span, changes in clinical practice provided opportunities to incorporate modifications in the patient tower design.

Norman Morgan, principal-in-charge with HKS, who served as healthcare planner on the original project, notes, “On the patient and family side, MD Anderson’s goals were to maximize the number of patient rooms per floor using current industry and best practice standards, improve wayfinding for families and visitors, and add family spaces and amenities on the floor.” Since the ‘90s, patient room standards have increased significantly. The typical 185-square-foot patient room has increased to 225 square feet.

“To increase the square footage in each of the patient rooms, the originally designed inset building corners were filled in,” Morgan says. “In addition, 50,000 square feet of additional space was provided through a super column structure. This innovative design allowed the client to add four more patient rooms per floor. It also permitted each patient room to increase in size to incorporate dedicated family zones—with pull-out sleeping accommodations and a television—as well as specific caregiver areas.”

The floor configuration is also noted for improving wayfinding. “When stepping off of the elevator, a direct line of sight is provided to the reception desk. Included are more family waiting areas, consultation rooms, decentralized charting stations, and team meeting rooms, as well as 12 publically accessible hand-washing sinks on each floor,” Morgan says.


Distinctive caregiving

MD Anderson’s project challenges also included decentralizing nurses’ stations, improving staff and patient circulation, and streamlining support areas within the new addition.

Studies show caregivers who have direct visibility of patients often are able to identify problems before they register on monitoring equipment. “Instead of charting patient care at two main nurses’ stations per unit, the addition incorporates decentralized, room-side nurse substations to draw the nurse closer to the patient, and lower the risk of interruptions and medical errors,” Morgan says.

“Specialized pass-throughs at nurses’ substations are provided for clean and soiled linen, and biohazard waste,” says Michael Ufer, interior designer with HKS. “This reduces the need for nurses at the bedside to travel back and forth to the clean supply, medication rooms, and soiled utility rooms.”

Placement of outboard toilets in patient rooms is a key factor in increasing patient visibility from the nurses’ station. “While this provided increased observation and speed to assess the patients, privacy was still an issue,” Ufer says. “As a result, the windows are designed to minimize casual view into the room by lowering the window used only by nurses sitting at the nurses’ substations, and supplying integral blinds and cubicle curtains inside the room.”

In addition, the new design relocates the stairs to the building core, providing additional unit support space. The family waiting areas also were brought into the new elevator lobby to provide necessary support functions closer to the patients and staff. Staff locker rooms with adjacent shower rooms and large conference rooms are provided in a centralized location for floor use and quick access from the service and staff elevators.


Upward design

Finding a lighter exterior façade material that was an exact match to the existing exterior façade posed an interesting design dilemma.

Glass fiber reinforced concrete (GFRC) was the answer, according to Morgan. GFRC, a precast system, creates a 1-to-1.5-inch-thick façade, versus the traditionally 7-to-9-inch precast concrete system, allowing less weight to be attached to the vertical structure. This allowed us to add two more floors to the building,” he says.

In addition, the façade wasn’t easy to match after 20 years of wear and tear. “To complement the existing precast concrete, several GFRC materials were studied at the factory, Morgan says. “Once we had two to three selections, large mockup panels were hoisted by crane next to the existing structure to select the best match.”

Next, how can construction proceed atop an existing structure without creating distractions for patients, their families, and staff? To address this challenge, the design team created a mechanical floor between the existing and new building to facilitate building systems operations, and create a buffer between the upper and
lower floors.

Plus, the high-rise design offers a unique building amenity. Since it is one of the tallest buildings in the medical center, an 8,000-square-foot enclosed observation deck provides panoramic views of the city.


Edgy engineering

Walter P Moore provided structural, civil, and traffic engineering services for this major expansion of MD Anderson Cancer Center. Services included support of the original master planning, final design services, and continued master planning support for ongoing expansions of the facility.

As part of this design-build project, the firm studied adding an additional two floors on top of the 10 floors previously planned for vertical expansion,” says Muhammad Cheema, structural engineering principal with Walter P Moore. “The team aggressively and creatively achieved this by commissioning a new wind tunnel study, modifying the wind resisting system to redistribute loads on the mat foundation, suggesting a lighter building cladding system, and using isolated strengthening with fiber composite reinforcement to upgrade the building for the 12-story addition.”

In response to owner concerns about construction noise and vibration, the team worked closely with a consultant to monitor and mitigate the impact of the construction on patients and sensitive equipment in the building. “This study determined that the noise and vibration would be within acceptable limits with only minor accommodations inside the building,” Cheema continues.

In addition, the structural engineering team added super columns that connect the fourth floor to the 12th to accommodate additional square footage needed in the patient, staff, and support spaces.

“The super columns, which were designed to have long, nonbraced lengths at the lower floors, are supported by the existing podium structure,” he adds. “The new floor areas use a creative floor framing strategy to redistribute as much load to the existing structure, thereby minimizing loads carried by the new addition.”


Building blocks

Like the other teams involved, the Texas Division of McCarthy Building Companies was challenged with building on top of a fully functional hospital facility. The existing 12 floors below the new addition had to remain in operation 24 hours a day. Each and every day, the hospital was open during construction.

Aside from the team’s priority to cause the least amount of disruption (noise and vibration) to the patients, visitors, and staff during construction, McCarthy focused on keeping the integrity of the roof during construction. New columns were attached to the existing roof as construction began overhead.

“The project was built in multiple phases,” says Ben Johanneman, project director, McCarthy Building Companies. “The first phase prepared the existing Alkek Tower for the vertical expansion and included selective demolition, temporary waterproofing activities, and installation of a tower crane and a personnel/material hoist. Despite the size of the project, McCarthy used only one crane throughout the project due to the severe constraints of the site by adjacent buildings and a major street.”

Five additional patient floors were built as shell space in addition to the construction of a mechanical floor and renovation of several areas within the existing building, including Level 12, which contains special air filtering systems dedicated to patients with compromised immune systems.

Building information modeling was used to aid in the mechanical, electrical, and plumbing coordination process, and to assist with communication of the schedule to the owner, including progress related to both structure and enclosure.

“The images derived from the program were included in meeting minutes, progress reports, requests for information, and others to promote expeditious and accurate communications between the design-build team and the owner,” Johanneman says.

From the improved wayfinding to the inviting waiting areas to the patient-centric rooms, the new Alkek tower addition continues MD Anderson’s goal of providing patients and guests with a warm and comforting hospital environment.

“In the coming years, we project an increasing demand for MD Anderson services,” says Janet Sisolak, project director at MD Anderson. “The expansion of Alkek Hospital was designed to foster mainstays of our MD Anderson culture: collaboration, coordination of care among many disciplines, and focus on the patient and their family. This environment is warm and inviting, and encourages healing. It’s what our patients expect and what they deserve.” HCD


Brian McFarlane, AIA, is Associate Principal/Director of Development, North America, at HKS, Inc. He can be reached at bmcfarlane@hksinc.com.